BLOOD TYPES

A blood type (also called a blood group) is a classification of bloodbased on the

presence or absence of inherited antigenic substances on the surface of red blood
cells (RBCs). These antigens may be proteins,carbohydrates, glycoproteins,
or glycolipids, depending on the blood group system. Some of these antigens are
also present on the surface of other types of cells of various tissues. Several of
these red blood cell surface antigens can stem from one allele (or an alternative
version of a gene) and collectively form a blood group system.[1] Blood types are
inherited and represent contributions from both parents. A total of 35human blood
group systems are now recognized by the International Society of Blood
Transfusion (ISBT).[2] The two most important ones areABO and the RhD antigen;
they determine someone's blood type (A, B, AB and O, with +, − or Null denoting
RhD status).

BLOOD GROUP SYSTEMS

A complete blood type would describe a full set of 30 substances on the surface of
RBCs, and an individual's blood type is one of many possible combinations of
blood-group antigens.[4] Across the 35 blood groups, over 600 different blood-
group antigens have been found,[5] but many of these are very rare, some being
found mainly in certain ethnic groups.

Almost always, an individual has the same blood group for life, but very rarely an
individual's blood type changes through addition or suppression of an antigen
in infection, malignancy, or autoimmune disease.[6][7][8][9] Another more common
cause in blood type change is a bone marrow transplant. Bone-marrow transplants
are performed for many leukemias and lymphomas, among other diseases. If a
person receives bone marrow from someone who is a different ABO type (e.g., a
type A patient receives a type O bone marrow), the patient's blood type will
eventually convert to the donor's type.

Some blood types are associated with inheritance of other diseases; for example,
the Kell antigen is sometimes associated with McLeod syndrome.[10] Certain blood
types may affect susceptibility to infections, an example being the resistance to
specific malaria species seen in individuals lacking the Duffy antigen.[11] The Duffy
antigen, presumably as a result of natural selection, is less common in ethnic
groups from areas with a high incidence of malaria.[12]

The ABO Blood Group System

There are four major blood groups determined by the presence or absence of two
antigens – A and B – on the surface of red blood cells:
 Group A – has only the A antigen on red cells (and B antibody in the
plasma)
 Group B – has only the B antigen on red cells (and A antibody in the
plasma)
 Group AB – has both A and B antigens on red cells (but neither A nor B
antibody in the plasma)
 Group O – has neither A nor B antigens on red cells (but both A and B
antibody are in the plasma)

The ABO system is the most important blood-group system in human-blood

transfusion. The associated anti-A and anti-B antibodies are
usually immunoglobulin M, abbreviated IgM, antibodies. ABO IgM antibodies are
produced in the first years of life by sensitization to environmental substances such
as food, bacteria, andviruses. The O in ABO is often called 0 (zero, or null) in
other languages.[13]
OTHER BLOOD GROUP SYSTEMS
 33 blood-group systems have been identified, including the ABO and Rh systems.[17] Thus, in
addition to the ABO antigens and Rh antigens, many other antigens are expressed on the RBC
surface membrane. For example, an individual can be AB, D positive, and at the same time M
and N positive (MNS system), K positive (Kell system), Lea or Leb negative (Lewis system), and
so on, being positive or negative for each blood group system antigen. Many of the blood group
systems were named after the patients in whom the corresponding antibodies were initially
encountered.

Phenotyp
Genotype
e

A AA or AO

B BB or BO

AB AB

O OO
 Red blood cell compatibility

 Blood group AB individuals have both A and B antigens on the surface of

their RBCs, and their blood plasma does not contain any antibodies against
either A or B antigen. Therefore, an individual with type AB blood can receive
blood from any group (with AB being preferable), but cannot donate blood to
any group other than AB. They are known as universal recipients.

 Blood group A individuals have the A antigen on the surface of their RBCs,
and blood serum containing IgM antibodies against the B antigen. Therefore, a
group A individual can receive blood only from individuals of groups A or O
(with A being preferable), and can donate blood to individuals with type A or
AB.

 Blood group B individuals have the B antigen on the surface of their RBCs,
and blood serum containing IgM antibodies against the A antigen. Therefore, a
group B individual can receive blood only from individuals of groups B or O
(with B being preferable), and can donate blood to individuals with type B or
AB.

 Blood group O (or blood group zero in some countries) individuals do not
have either A or B antigens on the surface of their RBCs, and their blood serum
contains IgM anti-A and anti-B antibodies against the A and B blood group
antigens.

 Therefore, a group O individual can receive blood only from a group O
individual, but can donate blood to individuals of any ABO blood group (i.e.,
A, B, O or AB). If a patient in a hospital situation were to need a blood
transfusion in an emergency, and if the time taken to process the recipient's
blood would cause a detrimental delay, O negative blood can be issued.

 Because it is compatible with anyone, O negative blood is often overused
and consequently is always in short supply.[25]


  According to the American Association of Blood Banks and the British
Chief Medical Officer’s National Blood Transfusion Committee, the use of
group O RhD negative red cells should be restricted to persons with O negative
blood, as nothing else is compatible with them, and women who might be
pregnant and for whom it would be impossible to do blood group testing before
giving them emergency treatment.[25]


Plasma compatibility

Recipients can receive plasma of the same blood group, but otherwise the donor-
recipient compatibility forblood plasma is the converse of that of RBCs.[28] This is
because the antibodies responsible for adverse reactions are carried in the plasma:
type AB plasma carries neither anti-A nor anti-B antibodies and can be transfused
to individuals of any blood group, but they can only receive type AB plasma. Type
O carries both antibodies, so individuals of blood group O can receive plasma from
any blood group, but type O plasma can be used only by type O recipients.
Rh D antibodies are uncommon, so generally neither D negative nor D positive
blood contain anti-D antibodies. If a potential donor is found to have anti-D
antibodies or any strong atypical blood group antibody by antibody screening in
the blood bank, they would not be accepted as a donor (or in some blood banks the
blood would be drawn but the product would need to be appropriately labeled);
therefore, donor blood plasma issued by a blood bank can be selected to be free of
D antibodies and free of other atypical antibodies, and such donor plasma issued
from a blood bank would be suitable for a recipient who may be D positive or D
negative, as long as blood plasma and the recipient are ABO compatible

BLOOD TRANSFUSION
Blood transfusion is generally the process of receiving blood products into
one's circulationintravenously. Transfusions are used for various medical
conditions to replace lost components of the blood. Early transfusions used whole
blood, but modern medical practice commonly uses only components of the blood,
such as red blood cells, white blood cells, plasma, clotting factors, andplatelets.

A blood transfusion is a routine medical procedure that can be lifesaving. During a

blood transfusion, donated blood is added to your own blood. A blood transfusion
may also be done to supplement various components of your blood with donated
blood products. In some cases, a blood transfusion is done with blood that you've
donated ahead of time before you undergo elective surgery.
During a typical blood transfusion, certain parts of blood are delivered through an
intravenous (IV) line that's placed in one of the veins in your arm. A blood
transfusion usually takes one to four hours, though in an emergency it can be done
much faster.A blood transfusion boosts blood levels that are low, either because
your body isn't making enough or you've lost blood owing to surgery, injury or
disease.

Rh FACTOR

The Rh factor is simply a red blood cell antigen - just like the A antigen and the B
antigen that are used to determine your blood type. The Rh factor is named after
the Rhesus monkey, which is the animal where it was first identified.

The Rh factor is important when we learn about the Rh blood group system. The
Rh blood group system is a classification system for blood that depends on the
presence or absence of the Rh antigen - or factor - on your red blood cells.

In other words, you were either born with the Rh factors on your red blood cells,
like most people, or you were born without them, which is more rare, but
significant as we will learn in this lesson.

Since the Rh factor can be either present (+) or absent (-) we refer to people as
being either Rh positive if they have the Rh factor, or Rh negative if they do not.
 THE RHESUS SYSTEM
Rh  blood types were discovered in 1940 by Karl Landsteiner and Alexander
Wiener.  This was 40 years after Landsteiner had discovered the ABO blood
groups.  Over the last half century, we have learned far more about the processes
responsible for Rh types.  This blood group may be the most complex genetically
of all blood type systems since it involves 45 different antigens on the surface of
red cells that are controlled by 2 closely linked genes on chromosome 1.

The Rh system was named after rhesus  monkeys, since they were initiallyused in
the research to make the antiserum for typing blood samples.  If the antiserum
agglutinates your red cells, you are Rh+ .  If it doesn't, you are Rh- . 
 Despite its actual genetic complexity, the inheritance of this trait usually can be
predicted by a simple conceptual model in which there are two alleles, D and d. 
Individuals who are homozygous dominant (DD) or heterozygous (Dd) are Rh+. 
Those who The Rh system was named after rhesus  monkeys, since they were
initially are homozygous recessive (dd) are Rh- (i.e., they do not have the key Rh
antigens).

Clinically, the Rh factor, like ABO factors, can lead to serious medical
complications. The greatest problem with the Rh group is not so much
incompatibilities following transfusions (though they can occur) as those between
a mother and her developing fetus. 

 Mother-fetus incompatibilityoccurs when the mother is Rh- (dd) and her fetus is
Rh+ (DD or Dd).  Maternal antibodies can cross the placenta and destroy fetal red
blood cells.  The risk increases with each pregnancy.  Europeans are the most
likely to have this problem--13% of their newborn babies are at risk.  Actually only
about ½ of these babies (6% of all European births) have complications. 

With preventive treatment, this number can be cut down even further.  Less than
1% of those treated have trouble.  However, Rh blood type incompatibility is still
the leading cause of potentially fatal blood related problems of the newborn.  In the
United States, 1 out of 1000 babies are born with this condition.

Rh type mother-fetus incompatibility occurs only when an Rh+ man fathers a child
with an Rh- mother.  Since an Rh+ father can have either a DD or Ddgenotype,
there are 2 mating combinations possible with differing risks as shown below. 
Regardless of the father's genotype, if he is Rh+ and the mother is Rh-, doctors
assume that there will be an incompatibility problem and act accordingly.
 BLOOD DONATION
A blood donation occurs when a person voluntarily has blood drawn and used
for transfusions and/or made into biopharmaceutical medications by a process
called fractionation (separation of whole-blood components). Donation may be of
whole blood (WB), or of specific components directly (the latter called
apheresis). Blood banks often participate in the collection process as well as the
procedures that follow it.

Today, in the developed world, most blood donors are unpaid volunteers who
donate blood for a community supply. In poorer countries, established supplies are
limited and donors usually give blood when family or friends need a transfusion
(directed donation.
Many donors donate as an act of charity, but in countries that allow paid donation
some donors are paid, and in some cases there are incentives other than money
such as paid time off from work. Donors can also have blood drawn for their own
future use (autologous donation). Donating is relatively safe, but some donors have
bruising where the needle is inserted or may feel faint.

Potential donors are evaluated for anything that might make their blood unsafe to
use. The screening includes testing for diseases that can be transmitted by a blood
transfusion, including HIV and viral hepatitis. The donor must also answer
questions about medical history and take a short physical examination to make sure
the donation is not hazardous to his or her health. How often a donor can give
varies from days to months based on what he or she donates and the laws of the
country where the donation takes place. For example in the United States, donors
must wait eight weeks (56 days) between whole blood donations but only seven
days between platelet pheresis donations.[1]

The amount of blood drawn and the methods vary. The collection can be done
manually or with automated equipment that only takes specific portions of the
blood. Most of the components of blood used for transfusions have a short shelf
life, and maintaining a constant supply is a persistent problem. This has led to
some increased interest in autotransfusion, whereby a patient's blood is salvaged
during surgery for continuous reinfusion — or alternatively, is "self-
donated" prior to when it will be needed. (Generally, the notion of "donation" does
not refer to giving to one's self, though in this context it has become somewhat
acceptably idiomatic.)

Universal donors and universal recipients

With regard to transfusions of packed red blood cells, individuals with type O Rh
D negative blood are often called universal donors, and those with type AB Rh D
positive blood are called universal recipients; however, these terms are only
generally true with respect to possible reactions of the recipient's anti-A and anti-B
antibodies to transfused red blood cells, and also possible sensitization to Rh D
antigens. One exception is individuals with hh antigen system (also known as the
Bombay phenotype) who can only receive blood safely from other hh donors,
because they form antibodies against the H antigen present on all red blood cells.

Blood donors with particularly strong anti-A, anti-B or any atypical blood group
antibody are excluded from blood donation. The possible reactions of anti-A and
anti-B antibodies present in the transfused blood to the recipient's RBCs need not
be considered, because a relatively small volume of plasma containing antibodies
is transfused.
By way of example: considering the transfusion of O Rh D negative blood
(universal donor blood) into a recipient of blood group A Rh D positive, an
immune reaction between the recipient's anti-B antibodies and the transfused RBCs
is not anticipated. However, the relatively small amount of plasma in the
transfused blood contains anti-A antibodies, which could react with the A antigens
on the surface of the recipients RBCs, but a significant reaction is unlikely because
of the dilution factors. Rh D sensitization is not anticipated.
Additionally, red blood cell surface antigens other than A, B and Rh D, might
cause adverse reactions and sensitization, if they can bind to the corresponding
antibodies to generate an immune response. Transfusions are further complicated
because platelets and white blood cells(WBCs) have their own systems of surface
antigens, and sensitization to platelet or WBC antigens can occur as a result of
transfusion.
With regard to transfusions of plasma, this situation is reversed. Type O plasma,
containing both anti-A and anti-B antibodies, can only be given to O recipients.
The antibodies will attack the antigens on any other blood type. Conversely, AB
plasma can be given to patients of any ABO blood group due to not containing any
anti-A or anti-B antibodies.

Hemolytic disease of the newborn (HDN)

A pregnant woman can make IgG blood group antibodies if her fetus has a blood

group antigen that she does not have. This can happen if some of the fetus' blood
cells pass into the mother's blood circulation (e.g. a small
fetomaternal hemorrhage at the time of childbirth or obstetric intervention), or
sometimes after a therapeutic blood transfusion. This can cause Rh disease or other
forms of hemolytic disease of the newborn(HDN) in the current pregnancy and/or
subsequent pregnancies.

If a pregnant woman is known to have anti-D antibodies, the Rh blood type of

afetus can be tested by analysis of fetal DNA in maternal plasma to assess the risk
to the fetus of Rh disease.[22] One of the major advances of twentieth century
medicine was to prevent this disease by stopping the formation of Anti-D
antibodies by D negative mothers with an injectable medication called Rho(D)
immune globulin.[23][24] Antibodies associated with some blood groups can cause
severe HDN, others can only cause mild HDN and others are not known to cause
HDN.[3]

REFERENCES

WIKIPEDIA

COMPLETE NEET GUIDE

EXPLORING BIOLOGY
TEXT BOOK OF BIOLOGY CLASS XII